Limited Power of Attorney

COMPANY LETTERHEAD

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

LIMITED POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS, that I, {{principal_name}}, residing at {{principal_address}}, the undersigned Principal, do hereby make, constitute and appoint {{agent_name}}, residing at {{agent_address}}, as my true and lawful Attorney-in-Fact, for me and in my name, place, and stead, to exercise the following limited powers:

GRANT OF SPECIFIC POWERS

My Attorney-in-Fact is hereby authorized to perform the following specific acts:

1. To {{specific_power_1_description}} including, but not limited to, {{specific_power_1_details}}.

2. To {{specific_power_2_description}} including, but not limited to, {{specific_power_2_details}}.

3. To {{specific_power_3_description}} including, but not limited to, {{specific_power_3_details}}.

(Add additional specific powers as required, using numerical listing.)

DURABILITY CLAUSE (Optional)

This Limited Power of Attorney shall become effective immediately and shall not be affected by my subsequent disability or incapacity, or by the lapse of time, except as provided below.

Alternatively: This Limited Power of Attorney shall become effective on {{effective_date}} and shall remain in full force and effect until {{termination_date}} or until revoked by me, whichever occurs first.

LIMITATIONS ON AUTHORITY

This Grant of Authority does NOT authorize my Attorney-in-Fact to:

1. Make gifts of my property to himself/herself or to others.

2. Alter my Last Will and Testament or any other testamentary documents.

3. Exercise any powers not expressly granted herein.

4. {{other_specific_limitation}}.

GOVERNING LAW

This Limited Power of Attorney shall be governed by and construed in accordance with the laws of {{country/jurisdiction}}.

REVOCATION

This Limited Power of Attorney may be revoked by me at any time by delivering written notice of revocation to my Attorney-in-Fact.

INDEMNIFICATION

My Attorney-in-Fact shall not be liable for any loss that results from a mistake of judgment made in good faith, but shall be liable for willful misconduct or gross negligence.

SIGNATURE BLOCK

IN WITNESS WHEREOF, I have hereunto set my hand and seal this {{day}} day of {{month}}, {{year}}.

_____________________________

{{principal_name}} (Principal)

WITNESSES:

_____________________________

{{witness_name_1}}

{{witness_address_1}}

_____________________________

{{witness_name_2}}

{{witness_address_2}}

NOTARY ACKNOWLEDGMENT:

State of {{state}}

County of {{county}}

On this {{day}} day of {{month}}, {{year}}, before me, a Notary Public in and for said County and State, personally appeared {{principal_name}}, known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.

_____________________________

Notary Public

My Commission Expires: {{commission_expiration_date}}